The aim of this study was to scope published evidence on clinicians’ knowledge of pulse oximetry.
Background
Vital signs’ assessment is critical for the early detection of acute clinical deterioration. Oxygen saturation, measured using a pulse oximeter, is one of these signs. To use a pulse oximeter correctly, clinicians must have a thorough understanding of the principles underpinning this technology. Previous research has shown that clinicians often do not understand pulse oximetry at depth.
Design
A scoping review was conducted.
Method
A review of contemporary research was conducted to determine clinicians’ understanding of how to use a pulse oximeter. Eligibility criteria included studies published in English from 2019 onwards which examined clinicians’ knowledge of pulse oximetry. A search of CINAHL, MEDLINE, and PubMed databases identified 11 studies that met the inclusion criteria.
Results
Eleven relevant studies were identified. The findings of this review indicated that despite pulse oximeters being a commonly used clinical tool, clinicians using it often have little or no education regarding its use and therefore poor understanding of how to use it correctly.
Discussion
Clinicians’ knowledge of pulse oximetry continues to be poor. Undergraduate and clinical education focused on pulse oximetry is therefore needed to address this significant knowledge gap. Clinicians using pulse oximetry should reflect on their knowledge of this technology and not just basic user functions and address any gaps in their clinical knowledge.
Conclusion
Despite pulse oximetry being important for patient assessment, research indicates clinicians’ understanding of this technology remains poor. It is time for educators to address this significant knowledge gap.
{"title":"Do clinicians know how to use pulse oximetry? A scoping review","authors":"Malcolm Elliott RN, PhD , Jessica Allardice RN, MNP, BBiomedSc","doi":"10.1016/j.aucc.2025.101521","DOIUrl":"10.1016/j.aucc.2025.101521","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to scope published evidence on clinicians’ knowledge of pulse oximetry.</div></div><div><h3>Background</h3><div>Vital signs’ assessment is critical for the early detection of acute clinical deterioration. Oxygen saturation, measured using a pulse oximeter, is one of these signs. To use a pulse oximeter correctly, clinicians must have a thorough understanding of the principles underpinning this technology. Previous research has shown that clinicians often do not understand pulse oximetry at depth.</div></div><div><h3>Design</h3><div>A scoping review was conducted.</div></div><div><h3>Method</h3><div>A review of contemporary research was conducted to determine clinicians’ understanding of how to use a pulse oximeter. Eligibility criteria included studies published in English from 2019 onwards which examined clinicians’ knowledge of pulse oximetry. A search of CINAHL, MEDLINE, and PubMed databases identified 11 studies that met the inclusion criteria.</div></div><div><h3>Results</h3><div>Eleven relevant studies were identified. The findings of this review indicated that despite pulse oximeters being a commonly used clinical tool, clinicians using it often have little or no education regarding its use and therefore poor understanding of how to use it correctly.</div></div><div><h3>Discussion</h3><div>Clinicians’ knowledge of pulse oximetry continues to be poor. Undergraduate and clinical education focused on pulse oximetry is therefore needed to address this significant knowledge gap. Clinicians using pulse oximetry should reflect on their knowledge of this technology and not just basic user functions and address any gaps in their clinical knowledge.</div></div><div><h3>Conclusion</h3><div>Despite pulse oximetry being important for patient assessment, research indicates clinicians’ understanding of this technology remains poor. It is time for educators to address this significant knowledge gap.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101521"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Survivors of intensive care unit (ICU) admissions frequently experience psychological distress, with anxiety and depression being particularly prevalent. While the Hospital Anxiety and Depression Scale (HADS) is a commonly used instrument for assessing these conditions, there is limited evidence comparing its effectiveness with simpler tools like the Visual Analogue Scale (VAS) in ICU settings.
Objective
The objective of this study was to compare the accuracy of the VAS with the HADS for screening anxiety and depression in ICU patients.
Methods
A prospective, single-centre observational cohort study was conducted in a tertiary ICU. Adult patients with an ICU length of stay exceeding 48 h were enrolled. Anxiety and depression symptoms were self-reported using both the VAS (0–10 scale) for pre-ICU and ICU stay and HADS (0–21 scale). Borderline and probable anxiety/depression were defined by HADS scores ≥8 and ≥ 11, respectively. Paired t-tests compared VAS scores before and during ICU stay. Receiver operating characteristic curve analysis assessed the accuracy of the VAS against that of the HADS, with optimal cut-off values determined using the nearest method and bootstrapped confidence intervals.
Results
Of 135 participants (response rate: 93.8%, mean age: 63 ± 16 years; 42% female, median Acute physiology and Chronic Health Evaluation II score: 15), 48.2% and 47.4% met criteria for anxiety and depression, respectively. No significant differences were observed in pre-ICU versus in-ICU VAS scores. The area under the receiver operating characteristic curve for in-ICU VAS was 0.77 and 0.79 for borderline and probable anxiety and 0.73 and 0.76 for borderline and probable depression, respectively. Optimal VAS cut-offs were 4 and 3 for borderline and probable anxiety and 4 and 2 for borderline and probable depression, respectively.
Conclusion
The VAS demonstrated acceptable discriminatory capability compared to the HADS and may serve as a rapid, effective screening tool for anxiety and depression in ICU patients. Given the high prevalence of these conditions, further research is warranted to validate these findings and explore clinical integration.
{"title":"Accuracy of a visual analogue scale for screening anxiety and depression in patients admitted to an intensive care unit: A comparison with the Hospital Anxiety and Depression Scale","authors":"Anil P. Ramnani FCICM , Lillian Armellin FCICM , Sumeet Rai FCICM , Misty Purdy BSW MCouns , Elissa Jacobs MClinPsch , Kush Deshpande FCICM","doi":"10.1016/j.aucc.2025.101526","DOIUrl":"10.1016/j.aucc.2025.101526","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of intensive care unit (ICU) admissions frequently experience psychological distress, with anxiety and depression being particularly prevalent. While the Hospital Anxiety and Depression Scale (HADS) is a commonly used instrument for assessing these conditions, there is limited evidence comparing its effectiveness with simpler tools like the Visual Analogue Scale (VAS) in ICU settings.</div></div><div><h3>Objective</h3><div>The objective of this study was to compare the accuracy of the VAS with the HADS for screening anxiety and depression in ICU patients.</div></div><div><h3>Methods</h3><div>A prospective, single-centre observational cohort study was conducted in a tertiary ICU. Adult patients with an ICU length of stay exceeding 48 h were enrolled. Anxiety and depression symptoms were self-reported using both the VAS (0–10 scale) for pre-ICU and ICU stay and HADS (0–21 scale). Borderline and probable anxiety/depression were defined by HADS scores ≥8 and ≥ 11, respectively. Paired t-tests compared VAS scores before and during ICU stay. Receiver operating characteristic curve analysis assessed the accuracy of the VAS against that of the HADS, with optimal cut-off values determined using the nearest method and bootstrapped confidence intervals.</div></div><div><h3>Results</h3><div>Of 135 participants (response rate: 93.8%, mean age: 63 ± 16 years; 42% female, median Acute physiology and Chronic Health Evaluation II score: 15), 48.2% and 47.4% met criteria for anxiety and depression, respectively. No significant differences were observed in pre-ICU versus in-ICU VAS scores. The area under the receiver operating characteristic curve for in-ICU VAS was 0.77 and 0.79 for borderline and probable anxiety and 0.73 and 0.76 for borderline and probable depression, respectively. Optimal VAS cut-offs were 4 and 3 for borderline and probable anxiety and 4 and 2 for borderline and probable depression, respectively.</div></div><div><h3>Conclusion</h3><div>The VAS demonstrated acceptable discriminatory capability compared to the HADS and may serve as a rapid, effective screening tool for anxiety and depression in ICU patients. Given the high prevalence of these conditions, further research is warranted to validate these findings and explore clinical integration.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101526"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.aucc.2025.101524
Jialin Chen MN, RN , Ping Yu MN, CNS , Lan Liu MN, RN , Meiqing Chen BN, NP , Xujun Yuan BN, CNS , Yang Xu MN, RN , Nina Wang BN, NP , Min Zhu BN, NP
Objective
The objective of this study was to systematically analyse the incidence and influencing factors of medical adhesive–related skin injury (MARSI) in critically ill patients.
Methods
A systematic search of eight databases was conducted from their inception to October 10, 2025. Two trained researchers independently performed study screening, data extraction, and quality assessment. Statistical analyses were performed using R software. We performed meta-analyses to pool the incidence of MARSI and its influencing factors using a random-effect model. Subgroup and sensitivity analyses were conducted to explore heterogeneity and verify robustness.
Results
A total of 20 studies involving 4337 patients were included in this review. The pooled incidence of MARSI among intensive care unit patients was 25.21% (95% confidence interval [CI] = [17.99, 34.12]). Of all subtypes, skin stripping had the highest incidence, at 52.19% (95% CI = [39.69, 64.42]). This analysis identified eight factors significantly associated with MARSI: length of hospital stay (standardised mean difference = 0.562, 95% CI = [0.290, 0.835]), fever (odds ratio [OR] = 2.306, 95% CI = [1.540, 3.454]), skin oedema (OR = 5.739, 95% CI = [3.502, 9.405]), intravenous fluids (OR = 2.899, 95% CI = [1.550, 5.423]), mechanical ventilation (OR = 3.519, 95% CI = [2.128, 5.819]), sedatives (OR = 4.807, 95% CI = [1.798, 12.852]), antibiotics (OR = 2.427, 95% CI = [1.448, 4.066]), and Braden score (standardised mean difference = −0.424, 95% CI = [-0.635, −0.212]).
Conclusions
This systematic review and meta-analysis demonstrates a substantial incidence of MARSI in intensive care unit patients, with considerable variation in incidence rates across different MARSI subtypes. To mitigate the occurrence of MARSI, healthcare providers should prioritise early identification of at-risk patients based on established influencing factors.
Registration
This review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews (CRD42024566852).
目的系统分析危重症患者医用粘胶性皮肤损伤（MARSI）的发生率及影响因素。方法对8个数据库进行系统检索，检索时间为数据库建立至2025年10月10日。两名训练有素的研究人员独立进行研究筛选、数据提取和质量评估。采用R软件进行统计分析。我们采用随机效应模型进行meta分析，汇总MARSI的发生率及其影响因素。进行亚组分析和敏感性分析以探索异质性并验证稳健性。结果本综述共纳入20项研究，涉及4337例患者。重症监护病房患者MARSI的总发生率为25.21%（95%可信区间[CI] =[17.99, 34.12]）。在所有亚型中，皮肤剥离的发生率最高，为52.19% （95% CI =[39.69, 64.42]）。该分析确定了与MARSI显著相关的八个因素：住院时间(标准平均差= 0.562,95% CI =[0.290, 0.835]),发热(比值比(或)= 2.306,95% CI =[1.540, 3.454]),皮肤水肿(OR = 5.739, 95% CI =[3.502, 9.405]),静脉输液(OR = 2.899, 95% CI =[1.550, 5.423]),机械通气(OR = 3.519, 95% CI =[2.128, 5.819]),镇静剂(OR = 4.807, 95% CI =[1.798, 12.852]),抗生素(OR = 2.427, 95% CI =[1.448, 4.066]),和布莱登分(标准平均差=−0.424,95% CI = [-0.635,−0.212])。本系统综述和荟萃分析表明，重症监护病房患者的MARSI发生率很高，不同MARSI亚型的发病率差异很大。为了减少MARSI的发生，医疗保健提供者应根据确定的影响因素优先早期识别高危患者。本综述方案已在国际前瞻性系统综述注册（CRD42024566852）中前瞻性注册。
{"title":"Incidence and influencing factors of medical adhesive–related skin injury in critically ill patients: A systematic review and meta-analysis","authors":"Jialin Chen MN, RN , Ping Yu MN, CNS , Lan Liu MN, RN , Meiqing Chen BN, NP , Xujun Yuan BN, CNS , Yang Xu MN, RN , Nina Wang BN, NP , Min Zhu BN, NP","doi":"10.1016/j.aucc.2025.101524","DOIUrl":"10.1016/j.aucc.2025.101524","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to systematically analyse the incidence and influencing factors of medical adhesive–related skin injury (MARSI) in critically ill patients.</div></div><div><h3>Methods</h3><div>A systematic search of eight databases was conducted from their inception to October 10, 2025. Two trained researchers independently performed study screening, data extraction, and quality assessment. Statistical analyses were performed using R software. We performed meta-analyses to pool the incidence of MARSI and its influencing factors using a random-effect model. Subgroup and sensitivity analyses were conducted to explore heterogeneity and verify robustness.</div></div><div><h3>Results</h3><div>A total of 20 studies involving 4337 patients were included in this review. The pooled incidence of MARSI among intensive care unit patients was 25.21% (95% confidence interval [CI] = [17.99, 34.12]). Of all subtypes, skin stripping had the highest incidence, at 52.19% (95% CI = [39.69, 64.42]). This analysis identified eight factors significantly associated with MARSI: length of hospital stay (standardised mean difference = 0.562, 95% CI = [0.290, 0.835]), fever (odds ratio [OR] = 2.306, 95% CI = [1.540, 3.454]), skin oedema (OR = 5.739, 95% CI = [3.502, 9.405]), intravenous fluids (OR = 2.899, 95% CI = [1.550, 5.423]), mechanical ventilation (OR = 3.519, 95% CI = [2.128, 5.819]), sedatives (OR = 4.807, 95% CI = [1.798, 12.852]), antibiotics (OR = 2.427, 95% CI = [1.448, 4.066]), and Braden score (standardised mean difference = −0.424, 95% CI = [-0.635, −0.212]).</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis demonstrates a substantial incidence of MARSI in intensive care unit patients, with considerable variation in incidence rates across different MARSI subtypes. To mitigate the occurrence of MARSI, healthcare providers should prioritise early identification of at-risk patients based on established influencing factors.</div></div><div><h3>Registration</h3><div>This review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews (CRD42024566852).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101524"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.aucc.2025.101515
Arielle Jolly RN, GradCert ClinNurs PICU , Ashleigh E. Butler RN, PhD , Simon Erickson MBBS, FRACP, FFICANZA, FCICM , Kristen Gibbons PhD , Kylie Davies RN, PhD , Nick Williams MD, MBChB , Yetunde Odutolu MBChB, FCICM , Jacqueline Reid BscPsych, MEd , Kelly Higgins RN, BSN , Linda Thomas RN, GradCert ClinNurs Crit Care , Fenella J. Gill RN, PhD, FACCCN , The ANZICS Paediatric Study Group
Background
The death of a child is a catastrophic event, and to experience this loss within the complex environment of a paediatric intensive care unit (PICU) can be highly traumatic for parents. With current bereavement literature heavily focused on children with known life-limiting conditions, the unique grief experience of unexpected child death is poorly understood.
Aim
The aim of this study was to increase understanding of bereaved family members’ experience of care in a PICU after the unexpected death of their child.
Methods
Two focus groups and two interviews were conducted with adult family members of children who had died unexpectedly in a tertiary PICU 6 months to 5 years prior. A qualitative, constructivist approach was adopted, utilising semistructured discussions following a facilitation guide underpinned by meaning reconstruction framework as the guiding grief theory. Data were analysed thematically.
Results
There were 15 participants, including four fathers, 10 mothers, and one family friend. Participants shared vivid and emotional recollections of the death of their child, with a central concept of being broken. Five key themes captured participants’ experience of care in the PICU including respectful communication, meaningful time, memories we can live with, face(s) ofsupport, and involving the whole family. Participants described well-delivered elements of care that supported their bereavement needs, as well as poorly delivered care that contributed to their feelings of being broken.
Conclusion
Family members valued care that was respectfully communicated by a trusted clinician, provided choice over significant time periods and meaning-making opportunities at the end of life, and was inclusive of all family members. These insights offer guidance to improve PICU bereavement practices for unexpected deaths.
{"title":"Being broken: A qualitative study exploring unexpected death in the Paediatric Intensive Care Unit and the family experience of care","authors":"Arielle Jolly RN, GradCert ClinNurs PICU , Ashleigh E. Butler RN, PhD , Simon Erickson MBBS, FRACP, FFICANZA, FCICM , Kristen Gibbons PhD , Kylie Davies RN, PhD , Nick Williams MD, MBChB , Yetunde Odutolu MBChB, FCICM , Jacqueline Reid BscPsych, MEd , Kelly Higgins RN, BSN , Linda Thomas RN, GradCert ClinNurs Crit Care , Fenella J. Gill RN, PhD, FACCCN , The ANZICS Paediatric Study Group","doi":"10.1016/j.aucc.2025.101515","DOIUrl":"10.1016/j.aucc.2025.101515","url":null,"abstract":"<div><h3>Background</h3><div>The death of a child is a catastrophic event, and to experience this loss within the complex environment of a paediatric intensive care unit (PICU) can be highly traumatic for parents. With current bereavement literature heavily focused on children with known life-limiting conditions, the unique grief experience of unexpected child death is poorly understood.</div></div><div><h3>Aim</h3><div>The aim of this study was to increase understanding of bereaved family members’ experience of care in a PICU after the unexpected death of their child.</div></div><div><h3>Methods</h3><div>Two focus groups and two interviews were conducted with adult family members of children who had died unexpectedly in a tertiary PICU 6 months to 5 years prior. A qualitative, constructivist approach was adopted, utilising semistructured discussions following a facilitation guide underpinned by meaning reconstruction framework as the guiding grief theory. Data were analysed thematically.</div></div><div><h3>Results</h3><div>There were 15 participants, including four fathers, 10 mothers, and one family friend. Participants shared vivid and emotional recollections of the death of their child, with a central concept of <em>being broken.</em> Five key themes captured participants’ experience of care in the PICU including <em>respectful communication, meaningful time, memories we can live with, face(s) of</em> <em>support</em><em>,</em> and <em>involving the whole family.</em> Participants described well-delivered elements of care that supported their bereavement needs, as well as poorly delivered care that contributed to their feelings of <em>being broken.</em></div></div><div><h3>Conclusion</h3><div>Family members valued care that was respectfully communicated by a trusted clinician, provided choice over significant time periods and meaning-making opportunities at the end of life, and was inclusive of all family members. These insights offer guidance to improve PICU bereavement practices for unexpected deaths.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101515"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-29DOI: 10.1016/j.aucc.2026.101544
{"title":"Once I was excited, now I'm concerned: The proliferation of letters to the editor","authors":"","doi":"10.1016/j.aucc.2026.101544","DOIUrl":"10.1016/j.aucc.2026.101544","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101544"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intensive care units house critically acute patients requiring extensive treatments and specialised care. Highly trained healthcare providers work tirelessly to perform life-sustaining measures, but when all possible treatment options have been exhausted, it sometimes becomes necessary to withdraw treatment. This process places critical care nurses and the interprofessional teams at the centre of emotionally and ethically challenging end-of-life care.
Objectives
The objective of this review was to synthesise what is known about the types of moral, emotional, and psychological distress experienced by healthcare providers during treatment withdrawal in adult intensive care units and to summarise the support strategies described in the literature to mitigate these experiences.
Results
Nine studies met inclusion criteria, representing 883 healthcare professionals across eight countries. Emotional distress was linked to repeated exposure to death, patient–family relationships, and the act of extubation. Moral distress arose from perceived prolongation of suffering, contradictions with patient wishes, and exclusion from decision-making. None of the studies directly measured psychological distress, representing a critical gap. Nurses consistently reported the greatest burden, often coordinating care and supporting families while being excluded from withdrawal planning. Across all studies, institutionalised support strategies were absent, with providers relying on individual coping mechanisms.
Conclusion
Withdrawing treatment is a task that can lead to emotional and moral distress of healthcare professionals. This review highlights the disconnect between predictable distress and the absence of systematic institutional support. Collaborative planning, standardised withdrawal protocols, mandatory breaks, and structured debriefing could help transform withdrawal experiences into opportunities for meaningful end-of-life care.
Implication for practice
The findings suggest that institutionalising interprofessional collaboration, communication training, and postextubation debriefing could reduce moral distress and improve team resilience during terminal extubation procedures.
{"title":"Treatment withdrawal and distress: Recognising the need for better support in critical care—A scoping review","authors":"Louise Chartrand RRT, PhD , Trinh Nguyen-Lu RN, BN , Lea Soliman RRT , Nicole Harder RN, PhD, CHSE, CCSNE","doi":"10.1016/j.aucc.2025.101459","DOIUrl":"10.1016/j.aucc.2025.101459","url":null,"abstract":"<div><h3>Background</h3><div>Intensive care units house critically acute patients requiring extensive treatments and specialised care. Highly trained healthcare providers work tirelessly to perform life-sustaining measures, but when all possible treatment options have been exhausted, it sometimes becomes necessary to withdraw treatment. This process places critical care nurses and the interprofessional teams at the centre of emotionally and ethically challenging end-of-life care.</div></div><div><h3>Objectives</h3><div>The objective of this review was to synthesise what is known about the types of moral, emotional, and psychological distress experienced by healthcare providers during treatment withdrawal in adult intensive care units and to summarise the support strategies described in the literature to mitigate these experiences.</div></div><div><h3>Results</h3><div>Nine studies met inclusion criteria, representing 883 healthcare professionals across eight countries. Emotional distress was linked to repeated exposure to death, patient–family relationships, and the act of extubation. Moral distress arose from perceived prolongation of suffering, contradictions with patient wishes, and exclusion from decision-making. None of the studies directly measured psychological distress, representing a critical gap. Nurses consistently reported the greatest burden, often coordinating care and supporting families while being excluded from withdrawal planning. Across all studies, institutionalised support strategies were absent, with providers relying on individual coping mechanisms.</div></div><div><h3>Conclusion</h3><div>Withdrawing treatment is a task that can lead to emotional and moral distress of healthcare professionals. This review highlights the disconnect between predictable distress and the absence of systematic institutional support. Collaborative planning, standardised withdrawal protocols, mandatory breaks, and structured debriefing could help transform withdrawal experiences into opportunities for meaningful end-of-life care.</div></div><div><h3>Implication for practice</h3><div>The findings suggest that institutionalising interprofessional collaboration, communication training, and postextubation debriefing could reduce moral distress and improve team resilience during terminal extubation procedures.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101459"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients admitted to intensive care units (ICUs) are more prone to patient safety incidents (PSIs), with substantial negative effects. Patient safety culture (PSC) is seen as a crucial pillar to address these safety problems. The aim of our study was to evaluate the impact of the implementation of a PSIs reporting system on PSC in ICUs.
Methods
We conducted a quasi-experimental study in 15 ICUs in two Tunisian university hospitals. One hospital was chosen as the intervention site (10 ICUs), where a PSI reporting system was implemented, while the other served as the control (five ICUs). All 344 ICU professionals were invited for study participation (i.e., physicians, ICU specialised nurses, registered nurses, and nursing assistants). The primary outcome was the change in PSC dimensions, all assessed with the validated French version of the Hospital Survey on Patient Safety Culture. Two-way multivariate analysis of variance was used to determine trend changes in mean PSC dimension scores.
Results
During baseline assessment (M1), 284 professionals responded (167 in the intervention group and 117 in the control group). After the intervention, five PSC dimensions improved significantly in the intervention group: “Frequency of adverse events reported” (from 20.8% to 37.6%, p < 0.001), “Continuous improvement and organisational learning” (35.9%–48.3%, p < 0.001), “Teamwork within units” (47.3%–59.8%, p < 0.001), “Communication openness” (21.4%–36.4%, p < 0.001), and “Non-punitive response to error” (20.8%–38.5%, p < 0.001).
Conclusions
The findings provide important insights into how structured reporting systems can enhance PSC in resource-limited healthcare settings. Although the study was conducted in a single intervention site using a quasi-experimental design, the results remain valuable in highlighting viable strategies for safety improvement and may guide future larger-scale and multisite evaluations. Targeted reporting interventions can significantly improve PSC in ICUs, even within resource-constrained settings. Lasting impact requires structured monitoring to sustain and optimise these improvements.
{"title":"Fostering safer intensive care units: How incident reporting drives cultural change","authors":"Mohamed Ayoub Tlili ORN, PhD , Wiem Aouicha ORN, PhD , Nikoloz Gambashidze MD, PhD , Buchra Alshammari RN, PhD , Maha Dardouri ORN, PhD , Wejdene Mansour B.Sc., PhD , Hamdan Albaqawi RN, PhD , Salman Hamdan Alsaqri RN, PhD , Sameer Alkubati RN, PhD , Matthias Weigl Pysch., PhD , Houyem Said Latiri MD, MSc , Manel Mallouli MD, MSc","doi":"10.1016/j.aucc.2025.101485","DOIUrl":"10.1016/j.aucc.2025.101485","url":null,"abstract":"<div><h3>Background</h3><div>Patients admitted to intensive care units (ICUs) are more prone to patient safety incidents (PSIs), with substantial negative effects. Patient safety culture (PSC) is seen as a crucial pillar to address these safety problems. The aim of our study was to evaluate the impact of the implementation of a PSIs reporting system on PSC in ICUs.</div></div><div><h3>Methods</h3><div>We conducted a quasi-experimental study in 15 ICUs in two Tunisian university hospitals. One hospital was chosen as the intervention site (10 ICUs), where a PSI reporting system was implemented, while the other served as the control (five ICUs). All 344 ICU professionals were invited for study participation (i.e., physicians, ICU specialised nurses, registered nurses, and nursing assistants). The primary outcome was the change in PSC dimensions, all assessed with the validated French version of the Hospital Survey on Patient Safety Culture. Two-way multivariate analysis of variance was used to determine trend changes in mean PSC dimension scores.</div></div><div><h3>Results</h3><div>During baseline assessment (M1), 284 professionals responded (167 in the intervention group and 117 in the control group). After the intervention, five PSC dimensions improved significantly in the intervention group: “Frequency of adverse events reported” (from 20.8% to 37.6%, p < 0.001), “Continuous improvement and organisational learning” (35.9%–48.3%, p < 0.001), “Teamwork within units” (47.3%–59.8%, p < 0.001), “Communication openness” (21.4%–36.4%, p < 0.001), and “Non-punitive response to error” (20.8%–38.5%, p < 0.001).</div></div><div><h3>Conclusions</h3><div>The findings provide important insights into how structured reporting systems can enhance PSC in resource-limited healthcare settings. Although the study was conducted in a single intervention site using a quasi-experimental design, the results remain valuable in highlighting viable strategies for safety improvement and may guide future larger-scale and multisite evaluations. Targeted reporting interventions can significantly improve PSC in ICUs, even within resource-constrained settings. Lasting impact requires structured monitoring to sustain and optimise these improvements.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101485"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Each year, more than 30 million people worldwide are admitted to intensive care units (ICUs) with life-threatening illness or injury. While advances in intensive care have improved survival, many continue to face long-term consequences after discharge. Post–intensive care syndrome (PICS), encompassing physical, cognitive, psychological, and social impairments, profoundly affects everyday life, family dynamics, and the ability to return to previous activity levels. Prevalence estimates vary, but more than half of individuals surviving an ICU admission remain affected 1 year after discharge. Although research has often focused on isolated symptoms, less is known about how these domains interact and shape recovery. Exploring this interconnectedness from the perspectives of individuals with a previous ICU admission and their relatives is essential for guiding person-centred rehabilitation strategies.
Aim
This study explored how individuals with a previous ICU admission and their relatives experience the interconnections between physical, cognitive, psychological, and social domains of PICS in the months following discharge.
Methods
We conducted a secondary qualitative content analysis of data originally collected in a phenomenological-hermeneutic study. Semistructured single and dyadic interviews were carried out with 18 individuals with a previous ICU admission and 14 relatives (partners, parents, or children) at 3 and 6 months after ICU discharge. Participants were recruited from two Danish hospitals. Data analysis followed Elo and Kyngäs’ approach, combining deductive and inductive phases: the PICS framework guided the deductive coding, while inductive analysis allowed new themes to emerge. The study adhered to the Consolidated Criteria for Reporting Qualitative Research.
Findings
Participants described persistent challenges across all four PICS domains. These were rarely experienced in isolation but overlapped, shaping everyday struggles such as managing energy, coping with memory difficulties, and maintaining social connections. Relatives provided perspectives that both complemented and extended the accounts of individuals with a prior ICU admission, highlighting how the interplay between domains influenced recovery trajectories.
Conclusion
Recovery after critical illness is shaped by the interconnected nature of physical, cognitive, psychological, and social challenges, with fatigue emerging as a central factor affecting all domains. The findings underscore the need for integrated, multidimensional rehabilitation strategies that actively include both individuals with a previous ICU admission and their relatives.
{"title":"The interconnectedness of the post–intensive care syndrome domains: A qualitative study","authors":"Anette Bjerregaard Alrø RN, PhD , Helle Svenningsen RN, PhD , Rikke Overgaard CCN, MSc , Helene Korvenius Nedergaard MD, PhD , Hanne Irene Jensen CCN, PhD , Pia Dreyer RN, PhD , Anna Holm RN, PhD","doi":"10.1016/j.aucc.2025.101471","DOIUrl":"10.1016/j.aucc.2025.101471","url":null,"abstract":"<div><h3>Background</h3><div>Each year, more than 30 million people worldwide are admitted to intensive care units (ICUs) with life-threatening illness or injury. While advances in intensive care have improved survival, many continue to face long-term consequences after discharge. Post–intensive care syndrome (PICS), encompassing physical, cognitive, psychological, and social impairments, profoundly affects everyday life, family dynamics, and the ability to return to previous activity levels. Prevalence estimates vary, but more than half of individuals surviving an ICU admission remain affected 1 year after discharge. Although research has often focused on isolated symptoms, less is known about how these domains interact and shape recovery. Exploring this interconnectedness from the perspectives of individuals with a previous ICU admission and their relatives is essential for guiding person-centred rehabilitation strategies.</div></div><div><h3>Aim</h3><div>This study explored how individuals with a previous ICU admission and their relatives experience the interconnections between physical, cognitive, psychological, and social domains of PICS in the months following discharge.</div></div><div><h3>Methods</h3><div>We conducted a secondary qualitative content analysis of data originally collected in a phenomenological-hermeneutic study. Semistructured single and dyadic interviews were carried out with 18 individuals with a previous ICU admission and 14 relatives (partners, parents, or children) at 3 and 6 months after ICU discharge. Participants were recruited from two Danish hospitals. Data analysis followed Elo and Kyngäs’ approach, combining deductive and inductive phases: the PICS framework guided the deductive coding, while inductive analysis allowed new themes to emerge. The study adhered to the Consolidated Criteria for Reporting Qualitative Research.</div></div><div><h3>Findings</h3><div>Participants described persistent challenges across all four PICS domains. These were rarely experienced in isolation but overlapped, shaping everyday struggles such as managing energy, coping with memory difficulties, and maintaining social connections. Relatives provided perspectives that both complemented and extended the accounts of individuals with a prior ICU admission, highlighting how the interplay between domains influenced recovery trajectories.</div></div><div><h3>Conclusion</h3><div>Recovery after critical illness is shaped by the interconnected nature of physical, cognitive, psychological, and social challenges, with fatigue emerging as a central factor affecting all domains. The findings underscore the need for integrated, multidimensional rehabilitation strategies that actively include both individuals with a previous ICU admission and their relatives.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101471"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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